Slim Down to Ward Off Diabetes

PSYCHOLOGY TODAY PRESENTS ITS inaugural "HealthPsych" column, in which medical experts consider behavioral approaches to disease prevention and control. Future columns will address conditions including heart disease, cancer, asthma and menopause.

Diabetes is the seventh leading cause of death in the U.S., affecting more than 6 percent of Americans and depleting the nation of $98 billion a year in health-care costs. Currently, medical care is aimed at controlling blood sugar, blood pressure and lipids, to reduce vascular complications. Smoking cessation, healthy eating and adherence to prescribed medications are important behavioral aspects of diabetes management.

However, focusing on diabetes prevention may be more effective than focusing solely on treatment. Changing people's behavior is key. In fact, Finnish researchers found that subjects who shed just 10 pounds and increased their physical activity by approximately 30 minutes per day reduced their risk of type 2 diabetes,

Type 2 diabetes accounts for 90 percent of diabetes in the U.S. and is associated with increased age, obesity and a sedentary lifestyle. More than 80 percent, of individuals with type 2 diabetes are overweight. As Americans have become more obese (18 percent of Americans are obese and a staggering 60 percent are considered overweight), diabetes prevalence has increased dramatically. Thus, healthy lifestyle changes may help prevent type 2 diabetes.

Several studies suggest that changing behavior can affect diabetes risk. In the Finnish Diabetes Prevention Study, for example, 522 middle-aged overweight adults with impaired glucose tolerance were randomly assigned to a control or to an intervention group. The intervention group received individualized counseling for diet, physical activity and weight change, leading to a 58 percent reduction in risk of developing diabetes over the three-year trial. The results were recently published in the New England Journal of Medicine.

The Diabetes Prevention Program (DPP) is a randomized trial with more than 3,000 participants recruited from 27 centers across the U.S. that will determine whether intensive lifestyle intervention or medication can prevent or delay development of diabetes. Findings from DPR to be published soon, may confirm the role of behavior change in decreasing the risk of diabetes. In the meantime, based on prior studies, overweight individuals who are at risk for diabetes should work to achieve modest weight losses and gradually increase their physical activity.

Edited By Melbourne Hovell, Ph.D.